Verification and Certification of Non

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VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING (OF

PLEADING)

VERIFICATION AND CERTIFICATION

REPUBLIC OF THE PHILIPPINES   )


CITY OF ____________________   )   S.S.

I, ____________________,  Filipino, of legal age residing at


____________________, after being sworn to in accordance with law, deposes and
says that:

1. I am the Plaintiff in the above-entitled case;

2. The facts stated in the above complaint are true and correct to the best of my
knowledge and authentic records;

3. I have not commenced any action or filed any claim involving the same issues in
any court, tribunal or quasi-judicial agency and, to the best of my knowledge, no such
other action or claim is pending in them; and

4. If I should learn that the same or similar action or claim has been filed or is pending
after its filing, I shall report that fact within five (5) days from notice to the court or
where the complaint or initiatory pleading has been filed.

(Date and venue)

Signature of Affiant

JURAT

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